Amphetamine‐related intoxications in people living with HIV: An observational study in an emergency department in Barcelona (Spain) from 2018 to 2020

Abstract

Background: Stimulant drugs, particularly amphetamines, are more commonly implicated in drug-related deaths in people living with HIV; however, the clinical characteristics of amphetamine-related intoxication in people living with HIV are poorly described. Material and methods:We conducted a retrospective study in people living with HIV who were admitted for amphetamine-related intoxication to an emergency department of a teaching hospital between 2018 and 2021. Severe intoxication (SI) was arbitrarily defined as requiring admission to the emergency medical support unit and receiving medical treatment for ≥6 h. Results: In total, 170 male patients with a median age of 36.2 + 7.5 years were included in the study. A total of 77 (45.3%) individuals had mental disorders, and 120 (85.7%) had HIV-1 RNA suppression, with a median CD4 cell count of 696 (interquartile range 490-905). In total, 61 (37.9%) individuals were on ritonavir/cobicistat-based regimens. Presenting clinical syndromes included agitation in 60 (35.3%) subjects, anxiety in 37 (21.7%), psychosis in 27 (15.8%), chest pain in 26 (15.3%) and altered level of consciousness in 20 (11.7%). SI was observed in 48 (28.2%) individuals, 12 (7.1%) required admission to the intensive care unit, and two (1.2%) died.Altered level of consciousness (odds ratio [OR] 6.5; 95% confidence interval [CI] 2.2-18.9; p < 0.01), psychosis (OR 5.8; 95% CI 2.2-15.1; p < 0.01) and suicide attempt (OR 4.6;; p 0.01) were associated with SI in the adjusted analysis. Conclusions: Amphetamine-related intoxication causes high morbidity in people living with HIV. Healthcare providers serving these patients should consider incorporating harm-reduction measures in the prevention of amphetamine-related intoxication.

Editorial comment on: Amphetamine‐related intoxications in people living with HIV: An observational study in an emergency department in Barcelona (Spain) from 2018 to 2020

“…This issue of HIV Medicine offers us a very interesting study by Perelló et al, 11 who analysed the severity of and the substances most frequently implicated in poisoning by drugs of abuse in people living with HIV cared for in an ED. The authors also investigated parameters such as previous psychiatric history, types of antiretroviral pharmacological treatment or the most frequent reason for consultation.…”